Ethnicity And Adolescent Depression A Prevalence

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There are few data on depression among minority children and adolescents in the United States. The dearth of data on minority adolescents is not surprising, given the lack of data on adolescent depression in general. For example, there have been few community-based epidemiologic studies of adolescent depression. Perusing the studies that have been done, it is difficult to identify a coherent empirical pattern due to the great diversity in research designs, study populations, and methods of case ascertainment.

For example, Fleming and Offord (1990) identified nine epidemiologic studies of clinical depression and report that prevalence of current depression ranged from 0.4-5.7% in the five studies reporting such data. The mean prevalence of current major depression was 3.6%. Subsequent to that review, several other articles have appeared. Lewinsohn, Hops, Roberts, Seeley, and Andrews (1993) reported data from a large sample of high school students indicating a point prevalence for Diagnostic and Statistical Manual of Mental Disorders (3rd. rev. ed.) (DSM-III-R) (American Psychiatric Association, 1987) major depression of 2.6%. Garrison et al. (1992) reported 1 year prevalence rates of about 9% for DSM-III major depressive disorder in a large sample of middle-school students. Based on an epidemiologic survey of youths 6-17 years of age, Jensen et al. (1995) estimated prevalence of depression (Major Depressive Episode/ Dysthymia) to be 1.9% based on parent report and 2.8% based on child report. Adjusting for impairment, prevalences were 1.9% for both parent and child reports of depression. The Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) study (Shaffer et al., 1996) combined data from four sites for subjects 9-17 years of age and reported that the prevalence of major depression was 3.1% based on parent report and 4.8% based on youth report. Using their recommended impairment criteria, prevalence of major depression reported by the parent was 2.4% and by the youth was 2.6%.

What about studies that focus on depressive symptoms? School-based studies using the Beck Depression Inventory (BDI) have reported mean scores ranging from 6.0 to 103; the average was 8.6 across five studies (Baron & Parron, 1986; Doerfler, Felner, Rowlison, Raley, & Evans, 1988; Gibbs, 1985; Kaplan, Hong, & Weinhold, 1984; Ten, 1982). At least eight studies, all school-based, have used the Center for Epidemiologic Studies Depression Scale (CES-D; Doerfler et al., 1988; Garrison, Jackson, Marsteller, McKeown, & Addy, 1990; Manson, Ackerman, Dick, Baron, & Fleming, 1990; Roberts, Andrews, Lewinsohn, & Hops, 1990; Roberts & Chen, 1995; Schoenbach, Kaplan, Grimson, & Wagner, 1982; Swanson, Linskey, Quintero-Salina, Pumanega, & Holzer, 1992; Tolor & Murphy, 1985). These studies have reported mean scores for the CES-D in the range of 16-20, with an overall mean of about 17. Prevalence of depressive symptoms using a CES-D caseness criterion of 16 or greater is in the range of45-55%.

Given the limited number of epidemiologic studies of adolescent depression in general, it is not surprising that there have been few studies published focusing on race or ethnic status. Again, even among this small subset of studies the findings are not cohesive. Although some studies find no evidence of ethnic differences in adolescent depression (Garrison et al., 1990; Kandel & Davies, 1982; Manson et al., 1990), others report that minority adolescents report greater levels of depressive symptoms (Emslie, Weinberg, Rush, Adams, & Rintelman, 1990; Schoenbach et al., 1982), and still others that minority youth have lower levels of depression (Doerfler et al., 1988). But again, it is difficult to draw any firm conclusions concerning ethnic status and risk of depression from these studies, because they employ different measures of depression, and they also focus on different ethnic minority adolescents (African American, Hispanic American, Native American, etc.).

A number of studies have included Mexican-origin adolescents. For example, Weinberg and Emslie (1987) reported that in their sample of high school students, Anglos had the lowest rates of depression on both the BDI and the Weinberg Screening Affective Scale (WSAS), African Americans were intermediate, and Mexican Americans had the highest rates. Swanson et al. (1992) conducted a school-based survey in three cities in Texas and three in Mexico along the U.S.-Mexico border. The U.S. sample, comprising over 95% Mexican-origin adolescents, had a prevalence of 48% using the score of 16 or more on the CES-D.

Roberts and Sobhan (1992) analyzed data from a national survey of persons 12-17 years of age, comparing symptom levels of Anglo, African, Mexican-origin, and other Hispanic Americans using a 12-item version of the CES-D. Mexican-origin males reported more depressive symptoms than other males and the same was true for Mexican-origin females, although to a lesser extent. Roberts (1994) examined depression rates among Mexican-origin and Anglo adolescents sampled from middle schools in Las Cruces, New Mexico. The minority youth had significantly higher rates of depressive symptoms on both the 20-item CES-D and the WSAS. In a second analyses of these data, Roberts and Chen (1995) examined depressive symptoms among Anglo and Mexican-origin adolescents. The minority adolescents reported significantly more symptoms of depression than their Anglo counterparts. Prevalences were highest for Mexican-origin females.

Hovey and King (1996) report that 22.9% of a small sample (N = 70) of first- and second-generation Latino American adolescents reported critical levels of depressive symptoms using the Reynolds Adolescent Depression Scale (RADS; Reynolds, 1986). As a comparison, 12% of the standardization sample of RADS (Reynolds, 1988) reported a critical level of depression. Those adolescents experiencing a high level of acculturative stress were more likely to be depressed. Similar results were found in another study by Hovey (1998), which focused on Mexican American adolescents.

Roberts, Roberts, and Chen (1997) used data from an ethnically diverse sample of middle school students (N = 5,423) to examine ethnic differences in major depression. The point prevalence of DSM-IV major depression was 8.4%

without and 4.3% with impairment. Data were sufficient to calculate prevalences for nine ethnic groups. Prevalences adjusted for impairment ranged from 1.9% for youths of Chinese descent to 6.6% for those of Mexican decent. African and Mexican American youths had significantly higher crude rates of depression without impairment, but only the latter had significantly higher rates of depression with impairment. Multivariate (logistic regression) analyses, adjusting for the effects of age, gender, and socioeconomic status (SES), yielded significant odds ratios (OR) for only one group. Mexican American youths were at elevated risk for both depression without (OR = 1. 74, p < .05) and depression with impairment (OR = 1.71, p < .05). There was no significant interaction of ethnicity and SES in relation to depression.

In a recent study, Siegel, Aneshensle, Taub, Cantwell, and Driscoll (1998) examined whether there was an impact of race ethnicity on depressed mood among adolescents, independent of SES. A three-stage, area probability sampling frame was utilized to select 877 adolescents, ages 12-17 years, for an in-person interview. Compared with European, African, or Asian Americans, Latinos reported more symptoms of depressed mood, a finding that was independent of SES.

Katragadda and Tidwell (1998) studied 240 Hispanic high school students in rural California using the CES-D to assess depressive symptoms. Using the standard score of 16 or more, 50.8% met the criteria for depression. Defining scores of 21-30 as "moderate depression," the prevalence was 17.5% and for "severe depression," (scores of 31 and above), prevalence was 15.8%. These rates are higher than most other studies have found.

A recent review by Cole, Martin, Peeke, Henderson, and Harwell (1998) identified eight studies comparing African and European American youths on measures of depression. The studies all included or were entirely adolescent populations. The results were quite disparate. Two studies reported that African American youths scored higher on depression measures than did European American youths (Garrison et al., 1990; McDonald & Gynther, 1963). Five studies found no significant differences between African American and European American youth on measures of depression (Helsel & Matson, 1984; Lubin & McCollum, 1994; Reynolds & Graves, 1989; Treadwell, Flannery-Schroeder, & Kendall, 1995; Wrobel & Lachar, 1995). One study (Doerfler et al., 1988) revealed that Europeans scored higher than African American youths.

Cole and his colleagues (1998) obtained yearly self-report, peer nomination, and teacher-rating assessments of depression symptoms, anxiety symptoms, and social acceptance on two cohorts of African American (N = 139 and 184, respectively) and European American school children (N = 328 and 339, respectively), yielding a total of six waves of data between 3rd and 8th grade. Analyses demonstrated that the measures were equally valid across ethnic groups. Peer-nomination measures of depression and anxiety symptoms appeared to be biased, however, leading to the underestimation of psychopathology in African American children. Adjusting for this, African American youths evinced more signs of depression and anxiety in grades three, four, and five than did European American children. Such differences were not significant in grades six, seven, and eight.

Other ethnic groups have been studied much less. For example, Prescott et al. (1998), based on a two-stage epidemiologic survey of high school students in Hawaii, found no differences between Hawaiian and non-Hawaiian youths in terms of the prevalence of DSMR-III-R major depressive disorder and dysthymic disorder. For example, the prevalence of MDD (6 months) was 8.4 for Hawaiians and 8.5 for non-Hawaiians. Greenberger and Chen (1996) examined perceived parent-adolescent relationships and depressed mood among 173 early adolescents and 297 college students, all of European or Asian American background. Ethnic differences in depressed mood, not evident in the early adolescent sample, emerged in the college sample, with Asian Americans reporting more symptoms. Ethnic differences in depressed mood were reduced to nonsignificance when quality of parent-adolescent relationships was statistically controlled. The magnitude of associations between measures of parent-adolescent relationships and depressed mood was similar for European and Asian Americans at the same phase of adolescence.

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